Intervention

Question 1

What is active rest?

Answer 1

Small/safe amounts of activity

Question 2

What is a finding that might make you think traction would work well for a particular patient?

Answer 2

Peripheralizes with both flexion and extension

Question 3

What is a finding that might make you think manipulation would work well for a particular patient?

Answer 3

Centralized as much as they can, no symptoms distal to the knee, low fear avoidance, hypomobility of L-spine

Question 4

What is an exam technique that will identify a sensitized neural structure?

Answer 4

Nerve tension test (ex. slump test, SLR)

Question 5

What are the 3 phases that lead to development of a clinical prediction rule?

Answer 5

Derivation, validation, impact analysis

Question 6

What are some contraindications to manipulation?

Answer 6

Pregnancy, nerve root compression, prior spine surgery, bone disease, inflammatory disease, anticoagulants, diabetes, malignancy, high anxiety, history of dizziness with neck rotation

Question 7

What are some predictive factors that predict success with manipulation?

Answer 7

Symptoms < 16 days, hypomobility in L-spine, no symptoms distal to knee, at least 1 hip with >35 degrees IR, FABQ work subscale score <19

Question 8

What is the FABQ work subscale?

Answer 8

Fear avoidance questionnaire specifically about work

Question 9

In terms of FABQ subscale score, what scores do patients who do better with manipulations have?

Answer 9

Lower

Question 10

What is the single best predictor of success with manipulation?

Answer 10

Duration of symptoms

Question 11

What are the 2 most important prediction factors of success with manipulation?

Answer 11

Relatively acute pain and no symptoms below the knee

Question 12

Which has been shown to be more effective in the L-spine in the research: mobilization or manipulation?

Answer 12

Manipulation

Question 13

What is cavitation?

Answer 13

When dissolved gasses in synnovial fluid are feleased into the joint cavity

Question 14

How does manipulation vs non-thrust techniques compare in terms of cost of LBP patients?

Answer 14

Manipulation patients had shorter length of stay and lower PT costs

Question 15

What does a manipulation allow a patient to do?

Answer 15

Move more normally

Question 16

What are Phil’s bottom lines regarding manipulation

Answer 16

Safe and potentially very effective, low risk of harm, most PTs probably under-utilize, part of bigger picture (pt expectation, exercise, avoid dependency)

Question 17

What are some neural mechanisms/explanations for how manual therapy works?

Answer 17

Inflammatory mediators effected, gating, pain modulation circuitry, cortical changes

Question 18

In one study, they looked at shoulder mechanics before and after preforming a spinal manipulation. What did they find?

Answer 18

Manipulation didn’t change biomechanics (ROM, EMG, and kinematics) but did change pain

Question 19

How does manual therapy (manipulation) affect cytokines?

Answer 19

Reduces cytokine production and proinflammatory secretion

Question 20

What does the windup phenomena suggest?

Answer 20

Sensitization of the nervous system

Question 21

What is windup?

Answer 21

The same stimulus when applied repeatedly will produce a greater pain sensation

Question 22

How does manual therapy affect windup?

Answer 22

Decreases it

Question 23

What is the single biggest predictor of rotator cuff repair success?

Answer 23

Patient expectation

Question 24

When might you use leg traction on a patient?

Answer 24

If they aren’t able to centralize with extension

Question 25

When do you use traction on a patient?

Answer 25

When they have a positive response to a manual traction maneuver

Question 26

How do you determine optimal positioning for patient during traction?

Answer 26

Comfort, results of manual traction test, desired posturing

Question 27

What are the possible positions to put a patient in when applying lumbar traction?

Answer 27

Supine (knees and hips flexed to 90), supine (knees flexed feet on table), supine (hips/knees extended), prone

Question 28

What is the best positioning for cervical traction

Answer 28

Supine over sitting

Question 29

What are some variables that need to be considered when applying traction?

Answer 29

Angle of pull, amount of traction load

Question 30

What are the factors that need to be considered when selecting how much traction load to apply?

Answer 30

Patient irritability, weight of patient, diagnosis, type of table, limitation of traction machine, duration, continuous vs intermittant

Question 31

How much weight does it take for vertical separation of the lumbar spine?

Answer 31

1/2 body weight

Question 32

For the lumbar spine do PTs generally go for continuous or intermittent traction? Briefly describe the protocol.

Answer 32

Continuous. Ramped for 6-7 minutes getting on and coming off. Distract for 10-20 minutes.

Question 33

What is the theoretical mechanism for why traction works?

Answer 33

Creating a negative pressure and sucking material back into a better spot

Question 34

What are precautions and contraindications for traction?

Answer 34

Precautions: HTN, CV disease, anxiety, mild osteoporosis, acute pain Contraindications: Adverse response to manual traction, instability, cord compression, severe osteoporosis

Question 35

What is a positive crossed SLR sign?

Answer 35

RAising asymptomatic leg produces symptoms down the symptomatic leg

Question 36

What is a positive crossed SLR sign associated with?

Answer 36

Cross-disc herniation (poor prognosis)

Question 37

What types of patients is traction best for?

Answer 37

Patients who aren't centralizing/ have bigger problems